Calcified vs. Non-Calcified Tendinopathy of the Rotator Cuff: Clinical Presentations, Prognostic Implications, and Emerging Therapeutic Strategies

Rotator cuff tendinopathy is a common cause of shoulder pain and dysfunction, presenting in two primary forms: calcific and non-calcific. These subtypes differ significantly in their pathophysiology, clinical manifestations, and natural history, necessitating tailored diagnostic and therapeutic approaches. This review delineates the clinical presentations of calcific rotator cuff tendinopathy (RCCT), characterized by distinct pre-calcific, calcific, and post-calcific stages, and contrasts them with the more insidious, degenerative course of non-calcific rotator cuff tendinopathy. Diagnostic imaging, particularly musculoskeletal ultrasound, plays a pivotal role in differentiating these conditions, offering advantages in cost, accessibility, and dynamic, real-time assessment over MRI. Treatment strategies range from conservative management with NSAIDs and physical therapy to interventional techniques including ultrasound-guided barbotage, extracorporeal shockwave therapy, corticosteroid injections, and emerging regenerative therapies such as platelet-rich plasma and prolotherapy. Despite advances, further high-quality studies are needed to optimize individualized care per rotator cuff tendinopathy classification and to clarify long-term outcomes. This review highlights current evidence and clinical decision-making considerations to improve the diagnosis and management of rotator cuff calcific and non-calcific tendinopathies.